Citation Nr: 18146251 Decision Date: 10/31/18 Archive Date: 10/30/18 DOCKET NO. 16-40 898A DATE: October 31, 2018 ORDER Entitlement to special monthly compensation (SMC) based on aid and attendance/housebound status is denied. FINDING OF FACT The Veteran, as a result of his service-connected conditions, is not institutionalized and is not shown to be permanently bedridden or so helpless as to be in need of the regular aid and attendance of another person, nor is he substantially confined to his dwelling and its immediate premises. CONCLUSION OF LAW The criteria for an award of special monthly compensation based on the need for regular aid and attendance or housebound status are not met. 38 U.S.C. §§ 1114 (s), 5101, 5107, 5121 (2012); 38 C.F.R. § 3.350 (2018). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from January 1952 to December 1953. This matter is on appeal from a November 2015 rating decision. 1. Entitlement to special monthly compensation (SMC) based on aid and attendance/housebound status The Veteran contends that entitlement to SMC is warranted because, due to his age and service-connected PTSD, he needs help with his daily activities. See November 2015 Notice of Disagreement (NOD). SMC is payable to a Veteran for anatomical loss or loss of use of both feet, one hand and one foot, blindness in both eyes with visual acuity of 5/200 or less, or being permanently bedridden or so helpless as a result of service-connected disability that he or she is in need of the regular aid and attendance of another person. 38 U.S.C. § 1114 (l); 38 C.F.R. § 3.350 (b). Determination of this need is subject to the criteria of 3.352. Under 38 C.F.R. § 3.352, the factors considered to determine whether regular aid and attendance is needed include: inability to dress or undress, or to keep herself ordinarily clean and presentable; frequent need to adjust special prosthetic or orthopedic appliances which by reason of the particular disability requires aid (this does not include adjustment of appliances that persons without any such disability would be unable to adjust without aid, such as supports, belts, lacing at the back, etc.); inability to feed herself through loss of coordination of upper extremities or through extreme weakness; inability to attend to wants of nature; or incapacity, physical or mental, which requires care or assistance on a regular basis to protect a claimant from the hazards or dangers incident to his daily environment. 38 C.F.R. § 3.352 (a). It is not required that all of the disabling conditions enumerated in 38 C.F.R. § 3.352 (a) be found to exist before a favorable decision is permissible. Particular personal functions which the Veteran is unable to perform should be considered in connection with her condition as a whole. It is only necessary that the evidence establish that he is so helpless as to need regular aid and attendance, not that there is a constant need. 38 C.F.R. § 3.352 (a); Turco v. Brown, 9 Vet. App. 222 (1996). It is logical to infer, however, a threshold requirement that “at least one of the enumerated factors be present.” Turco, 9 Vet. App. at 224. “Bedridden” will be that condition which, by virtue of its essential character, actually requires that the claimant remain in bed. The fact that a claimant has voluntarily taken to bed or that a doctor has prescribed rest in bed for a greater or lesser part of the day to promote convalescence or cure is insufficient. 38 C.F.R. § 3.352 (a). The Veteran’s service-connected disabilities include PTSD, tinnitus, bilateral hearing loss, and onychomycosis affecting the bilateral feet and hands. The evidence does not show that the Veteran is permanently bedridden, blind in both eyes, or so helpless as to be in need of regular aid and attendance due to his service-connected disabilities. Despite the Veteran’s lay assertions regarding the severity of his PTSD, the medical evidence does not reflect that his PTSD or other service-connected disabilities result in the need of aid and attendance of another person. The VA examinations of record document the functional impact caused by the Veteran’s service-connected disabilities, including difficulty understanding soft spoken speech or speech in background noise caused by hearing loss and tinnitus and difficulty gripping objects and prolonged ambulation caused by onychomycosis. See January 2013 VA Skin and Audio examinations. The Veteran’s PTSD is manifested by several symptoms, including depression, sleep impairment, difficulty in interpersonal functioning and in stressful situations; however, his symptoms are not shown to include or result in neglect of personal appearance or hygiene or an inability to function independently or perform activities of daily living. See Janaury 2013 VA PTSD examination; January 2014 VA PTSD examination. Notably, in June 2016, the Veteran and his wife informed VA clinicians that, while he was experiencing memory problems and other PTSD symptoms, he remained independent in his activities of daily living. See June 2016 VA treatment record. The Board also finds probative that an August 2015 Examination for Housebound Status or Permanent Need for Aid and Attendance submitted by the Veteran also reflects that the Veteran is not confined to his bed, does not need assistance bathing or tending to his other hygiene needs, and does not require nursing home care or medication management. The physician noted the Veteran’s right eye visual acuity was 20/200 but there is no indication of blindness or visual acuity of 5/200 or less in the left eye or that his decreased visual acuity is due to a service-connected disability. Additionally, the physician who completed the August 2015 examination noted the Veteran is able to feed himself, prepare his own meals, and manage his financial affairs. See August 2015 Housebound/Aid and Attendance Examination. Given the foregoing, the Board finds the Veteran does not meet the qualifications for aid and attendance, as his service-connected disabilities do not result in anatomical loss or loss of use of both feet, one hand and one foot, blindness in both eyes with visual acuity of 5/200 or less, or being permanently bedridden or so helpless as a result of service-connected disability that he or she is in need of the regular aid and attendance of another person. Nevertheless, the Board must consider if the Veteran is entitled to SMC based on housebound status. To establish entitlement to special monthly compensation based on housebound status under 38 U.S.C. § 1114 (s), the evidence must show that a Veteran has a single service-connected disability evaluated as 100 percent disabling and an additional service-connected disability, or disabilities, evaluated as 60 percent or more disabling that is separate and distinct from the 100 percent service-connected disability and involving different anatomical segments or bodily systems; or, the Veteran has a single service-connected disability evaluated as 100 percent disabling and due solely to service-connected disability or disabilities, the Veteran is permanently and substantially confined to his or her immediate premises. 38 C.F.R. § 3.350 (i). In this case, the Veteran was awarded a total disability rating based upon individual unemployability (TDIU) in June 2015 based upon his service-connected PTSD disability alone. See June 2015 rating decision. Because the Veteran’s TDIU rating is based on a single disability, he meets the requirement for a service-connected disability evaluated as 100 percent; however, his remaining service-connected disabilities do not have a combined 60 percent rating, as they are each separately rated 10 percent. See 38 C.F.R. § 4.25. Moreover, there is no lay or medical evidence showing the Veteran is permanently and substantially confined to his immediate premises because of his service-connected disabilities. The Board acknowledges the Veteran’s statements that he requires the assistance of another person because of his service-connected PTSD and notes that he can attest to factual matters of which he has first-hand knowledge, such as ongoing physical problems and symptoms. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005). However, the Veteran has not asserted that his service-connected disabilities have rendered him housebound or in need of aid and attendance of another. Accordingly, the preponderance of the evidence is against the claim; there is no doubt to be resolved; and the claim for aid and attendance compensation based on a need for the regular aid and attendance of another person and/or on being housebound is not warranted. R. FEINBERG Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A.J. Turnipseed, Counsel